Ethacrynic acid
EDECRIN
What it isNKCC2-inhibiting loop diuretic; edema when a non-sulfonamide option is required.
Why this oneIts lack of a sulfonamide group is its defining niche among loop diuretics.
What limits itOtotoxicity is greater than with other loops; electrolyte depletion and high cost otherwise mirror the class.
FDA-approved for
- edema (1967)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Edema / diuresis | adult | 50 mg QD after a meal | 50-200 mg daily | 200 mg BID |
| Edema / diuresis | pediatric (excl. infants) | 25 mg QD | individualized |
Titration Adjust in 25-50 mg increments; escalate over successive days
Renal Undefined
Hepatic Undefined
Instructions
- Take after meals
- Weigh patient before and during therapy
- Correct electrolyte imbalance; intermittent/alternate-day dosing after dry weight achieved
Contraindications
- Anuria
- Infants
- Severe watery diarrhea from the drug (discontinue, do not rechallenge)
Cautions
- Fluid/electrolyte depletion; dose-related excessive diuresis
- Ototoxicity (deafness, tinnitus, vertigo)
- GI bleeding
- Discontinue in worsening azotemia/oliguria in severe renal disease
Adverse reactions
- GI: anorexia, nausea, vomiting, diarrhea (incl. profuse watery diarrhea)
- Ototoxicity: deafness, tinnitus, vertigo
- Hyperuricemia/acute gout
- Hypoglycemia (excess doses)
- Agranulocytosis/neutropenia, thrombocytopenia
- Headache, fatigue, confusion
Pregnancy No adequate studies; animal studies showed no teratogenicity; use only if clearly needed.
Lactation Undefined
NO BOXED WARNINGS
Principal riskThe highest ototoxicity of the loop diuretics
Cost, est. cash$10–$300/month
Generic entry2016
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityVolume depletion and electrolyte disturbances; kidney function and interacting medications modify risk.
Mechanism of action: Ethacrynic acid ballicule
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Memory aids: mascots and interaction avatars
Bananas dispersing → ↓ serum potassium
